Penetrating Skull Base Injury and Postoperative Infection

Abstract

A 65-year-old male with past medical history of atrial fibrillation on Warfarin sustained a fall resulting in impalement of a wood stick through the oral cavity and into the anterior cranial fossa. The object entered the gingivolabial sulcus and passed through maxillary and ethmoids sinuses penetrating the anterior skull base, extending intracranially to corpus callosum (Figs. 15.1 and 15.2). The patient was neurologically intact upon presentation, with normal vision, and did not have a frank CSF leak. Urgent CT angiogram was obtained and showed displacement of anterior cerebral arteries without visible vessel injury (Fig. 15.3). After discussion with Neurosurgery, his anticoagulation was reversed, and he was emergently taken to the operating room for controlled removal of foreign body and skull base repair under endoscopic guidance, and possible craniotomy.